First, you and my doctor are in total agreement on this and I trust my doctor. What has me scratching my head is there are new technologies, that have been approved by the FDA, that can accurately spot things like developing heart disease early enough that it can be managed through lifestyle changes before it develops. However these technologies aren't made available in doctors offices because insurance won't pay for the tests. It seems that it would be less expensive for the insurance companies to pay for the test that can spot a future heart attack, or stroke, rather than pay for the heart attack or stroke itself. The only reason I can think of that this wouldn't be the case is where enough people died suddenly so they wouldn't have to pay for care to make it profitable. Am I incorrect in my thinking?

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For example, the notion of insurance itself. Look at other types of insurance--auto, home, business, E&O, term life (not whole life). What do they all have in common? The owner of the policy does not want to collect! Collecting on it means something bad happened. He bought insurance just in case something did, but he was actually hoping to pay premiums indefinitely while never collecting. He expects--and hopes--for it to be a net expense. That's the true nature of insurance. This is how insurance companies are even able to exist. If it weren't for all of the people willing to pay in more than they collect, there wouldn't be any reason for such a business. But people want to do precisely that. As a consequence, insurers want your business, and they're forced to lower premiums to be competitive. Auto insurance companies are very, very competitive for safe drivers because those drivers are very, very profitable to them.

Health insurance, on the other hand, has become its own animal. Many people intend to use it. Some are mega users. Such people quickly go through their deductibles, have no interest in staying in good health, and demand every test known to man. This is a small fraction of users, but they have a huge influence on the system. Many others aren't as bad, but they still strain the system. I have a friend who eats well, exercises, and is in good shape. He goes to doctor several times a year at least. (I've been once in about ten years.) The point is that he's constantly invoking his insurance rather than thinking about what things cost and making a decision. This is a highly intelligent financial guy, but he isn't thinking about costs at all--just whether or not he's "covered". And if he's already covered, let no test not be done! (As an aside, the same guy has a beautiful dog that I've dogsat many times. One time the dog puked green. His response? Take her to the vet! Don't think, don't get online, don't ignore the problem, just take her to the doc! Never mind that that would require hours on my part, no no no. Just take her to the vet. My response was to get online and do a little research. Very typical problem. Fed the dog some plain boiled chicken and rice, and no more problem. Likewise when I got a nosebleed one time, his immediate response: you should go to the doctor! Never mind that it was dry outside, my allergies had been acting up, that I'd been blowing my nose a little forcefully, that the nosebleed was from one nostril, and that it quickly stopped. Go to the doctor!)

IF health insurance were more like other types of insurance, deductibles would be higher and premiums would be lower. Doctors wouldn't be looking to the insurance companies to get paid (just like an auto shop is not looking to your insurance company to get paid for oil changes, new tires, etc.). They'd have to collect. So the price for things would be a lot lower (by about 70%). Doctors would have to understand and explain prices before providing care. It could actually be run like a business (and the average business is far easier to run than a doctor's office nowadays, given all the regulatory paperwork).

Under this type of system, I'd be all for your getting that preventative procedure. It'd be completely your decision, as you'd be the one paying for it, not the insurance company. If it were cutting edge, it'd likely be expensive (as all cutting edge things are). But over time, the price would come down (as the business of that cutting edge technology expanded).

This isn't the world we live in, though. Such a world cannot exist if Medicare or Medicaid exists. The existence of such programs necessarily lead to the elimination of the independent doctor/owner. Such systems allow for the mega users to strain the system. They encourage fraud, as well as the ordering of unnecessary tests. Insurers respond by trying to deny tests, such as the one you mentioned. Strictly from a doctor-patient point of view, IF the test you mentioned is highly effective at identifying potential heart disease, it makes sense to get it. From an insurer's point of view, it's a cost, and it could very well lead to even greater costs down the line if it helps prolong a mega user's life. That could happen even if the patient is extremely healthy at the time, for as we grow older, the chance of something going wrong just continues to climb.

The bottom line is that in the scenario you provided, the insurance company is an interested party. (Well, legally speaking.) You're looking to them to pay for something you want. That is the essence of the conflict. When you go to get an oil change, though, the only party you're consulting with is the one providing the service. If they demand an exorbitant price, you go down the street, and either they adjust or they go out of business.

Business transactions aren't perfect by any stretch. Nothing is perfect. There are plenty of scammers in this world. They're in every field. Speaking for myself, though, I'd much rather deal with just the person in front of me rather than some faceless, soulless d!ckbag on the phone somewhere.